Module 5 Flashcards
Components of PostPartum Assessment
- Vitals -Emotional
- Fundus - Lochia
- Bladder - Perineum
- Breasts -Cardiovascular
- Pain - Bowels
- Extremeties
Involution
Changes of the reproductive organs to return to prepregenancy state. After birth
Mostly Uterus
Can take 5-6 weeks
Subinvolution
Failure of the uterus to return to prepregnancy state after 6 weeks
Common Causes of Subinvolution
- Infection
- Retained fragments of placenta
Signs of Subinvolution
- Bigger then expected Fundal Height after 6 weeks
- Continued Lochia Rubra
- Pelvic pain
- Heaviness
- Fatigue
Nursing care for Subinvolution
- Teach about normal changes to expect
- Report fever, persistent pain, Red lochia , foul smelling vaginal discharge
- Teach how to palpate fundus and what is normal
If admitted to hospital:
- Assist with medical therapies
- Providing analgesics
- Comfort measures.
Fundus
- Should be felt midline at or below umbilicus
- Grapefruit size mass
- Should descend at predictable rate
- Descend 1cm/day
- no longer palpable after 10 days
- Full Bladder can displace fundus
Afterpains
- Intermittent contractions similar to mestrual cramps
- Decreases in 48hrs
- More common in women who have had more then 1 pregnancy
Why does breastfeeding sometimes cause afterpains
- Releases oxytocin causing the uterus to contract.
Lochia
- Vaginal discharge after delivery
- Composed of lymph, blood and endometrial tissue
- Menstraul or fleshy odor
3 types of Lochia
- Lochia Rubra
- Lochia serosa
- Lochia Alba
Lochia Rubra
- Red
- Composed mostly of blood
- Lasts 3 days after birth
Lochia Serosa
- Pink
- Blood and mucous
- 3rd - 10th day after birth
Lochia Alba
- Clear, Colorless or white
- Mostly Mucous
- 10th-21st day after birth
Components of Lochia Assessment
- Character
- Color
- Odor
- Consistency
- Clots Number + Size
- Amount
Scant Amount
Less then 5cm soiled
Light Amount
Less then 10 com soiled
Moderate Amount
Less then 15 cm Soiled
Large Amount
Larger then 15 cm soiled or full pad in 2 hours
Excessive Amount
Pad saturated in 15 min
Lochia Nursing Considerations
- Assess fundus at routine intervals
- Explain purpose of fundal assessment and interventions
- Teach how to assess fundus
- Message soft or boggy fundus to promote contractions
- Urinary status: full bladder could prevent contractions
Normal Lochia Sequencing teachings and what to report
- Foul Smelling Lochia
- Lochia Rubra that lasts more then 3 days
- Unusually Heavy Flow
- Lochia that turns bright red after already progressing to serosa or Alba
- Large clots, specially if followed by lochia Rubra.
Cervix
- Soft immediately after birth
- Regains muscle, not as tight as prepregnancy state
- 2-3 days to shorten, firm and regain form
Ectocervix
- Bruised with lacerations
- Can cause infections
Vagina
- Rugae dissapear and vaginal walls become smooth to allow for expansion
- Reappear 3 weeks postpartum
- Regains most prepregnancy form after 6 weeks
- Vaginal mucosa thickens when ovarian function reoccurs.
Patient Teachings of Vagina
- Safe to resume sex when bleeding stops and episiotomy heals
- Vagina does not lubricate well before 6 weeks postpartum and longer when breastfeeding.
Episiotomy or lacération of Perineum
- Heals within 2-3 weeks
- Assess for REEDA
- Vulvar hematoma/bruising
- Hemmerrhoids worsen from pressure during birthing
Nursing Considerations for Perineum Episiotomy
- Cool compress for 1st 24hrs
- Heat application after 24 hrs (site bath warm packs)
- Hygenic measures ( peri bottle after each void)
- Topical medications ( witch hazel, benzocaine, hydrocortisone with promoxine
- Donut ring pillows for sitting.
Normal Blood loss at delivery
500 mL vaginal
1000 mL csection
Post Partum Bradycardia
50-60 BPM
Can last 48 hrs
Excess Fluid is excreted by..
- Diuresis ( increased urination)
- Diaphoresis ( profuse perspiration)
Diuresis
Increased Urination
3L /day
Diaphoresis
Profuse perspiration
most common at night
last 2-3 days
Post Part Blood Values
- Stabilize after 12 days
- Fully stabilized by 8 weeks
Coagulation
- Blood Clotting higher during pregnancy/4-6 weeks postpartum
- Ability to Lyse does not increase
- Risk of blood clot formation
Risks of blood clot formation
- Csection
- Vericose veins
- Delayed abulation
- Venous Stasis
Postpartum Blood Clot assessment
- Presence of dyspnea
- Tachycardia
- unilateral calf swelling/pedal edema
- Positive Homans sign
Blood Clot prevention Teachings
- Encourage ambulation
- Rational for prophylactic VTE therapy
- Encourage use of pneumatic Compression Devices.
Heart Rate Assessment
Brady cardia is NORMAL
Tachycardia is ABNORMAL
Nursing care for Diaphoresis
- Provide frequent showers/sponge baths
- Educate that this is temporary
Assessment of Legs for Thrombosis
- Redness
- Warmth
- Tenderness to touch
- Homans sign
Teaching for Orthostatic Hypotension
- Assist with ambulation
- Sit at the edge of bed before standing
Post Partum Diuresis
- starts within 12 hours postpartum
- up to 3000 mL / 24 hrs
What does urinary distention cause
- Can cause excessive bleeding
Bladder Assessment
- Distention
- Urination Frequency
Urination assessment
- Frequency
- Color
- Amount
- Odor
Postpartum Bladder Distention
- Decrease Muscle tone of bladder and ureters
- Bladder fills quickly but it does not completely empty
- May not feel urge to void or feel her full bladder
Breastfeeding mothers
- Colostrum expressed before lactation
- Tenderness persists for 48 hours after lactation begins
Non-Breastfeeding Mothers
- Engorgement resolves and discomfort decreases in 24-36 hours
- Breast binder or tight bra, ice packs, fresh cabbage leaves, mild analgesics used to relieve discomfort.
Breast Assessment
- Size Shape and Symmetry
- Engorgment
- Check Nipples for cracks, redness, blisters, size and shape
Engorged breast
- Breast is hard, erect and uncomfortable
- Nipple maybe to hard and erect for newborn to grasp
Patient teaching for Breasts
- Comfortable bra
- avoid nipple stimulation if not breast feeding
- Wash with water to avoid drying effect of soap.
Bowels Postpartum
- Normal activity as progesterone levels decrease
- Constipation
Bowel Assessment
- Flatus
- Bowel Sounds
- Bowel Movement
Nursing care for postpartum Bowel
- Encourage fluid
- Add fibre to diet
- Ambulate
- Administer stool softener
Homans Sign
Calf pain experienced upon dorsiflexion of the foot, indication of thrombophlebitis
Emotional Assessment
- Bonding
- Family Interaction
- Support
- Physical contact with newborn
BUBBLE-HE
- Breasts
- Uterus
- Bladder
- Bowel
- Lochia
- Episiotomy
- Homans Sign
- Emotions/Bonding
postpartum Blues
- conflicting feelings of joy and emotional let down
- May feel let down bu overall finds pleasure in life
- Reassure mom that these are normal feelings and temporary.
